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Year 2 Neuro > Diseases of the spinal cord > Flashcards

Diseases of the spinal cord Flashcards

1
Q

What are the main motor signs of upper motor neuron disease

A

No muscle wasting
Increased tone
Increased reflexes, extensor plantar (toe goes up, normal in <6 months)
Pyramidal pattern of weakness

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2
Q

Where are motor signs visible from

A

The area below lesion
Often bilateral

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3
Q

What are the sensory signs of spinal cord pathology

A

Loss of vibration sense
Pain
Temperature
proprioception

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4
Q

What are the motor signs in LMN pathologies

A

Decreased tone
Decreased reflex
Muscle wasting

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5
Q

What are expected signs of cord patholgy

A

Issues with bladder and bowel function.

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6
Q

Why are reflexes increased in UMN disease

A

The UMN usually inhibits spinal reflexes, so disease will prevent this inhibition.

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7
Q

What type of response is the extensor plantar

A

Withdrawl response, lost within 6 months as your learning to walk and upper motor neurons develop

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8
Q

What is a pyrammidal pattern of weakness

A

Upper body: the flexors are stronger than the extensors which extends from fingers to shoulder
Lower Body: extensors > flexors, usually a very straight leg.

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9
Q

What is spastic tetraparesis?

A

When the lesion is in the cervical cord, causing weakness of all 4 limbs

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10
Q

What is Spastic paraperisis

A

When the lesion is in the thoracic region, and both legs are involved

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11
Q

what is the difference between spastic tetraparesis and spastic paraparesis?

A

Tetraparesis: involves weakness of all 4 limbs
Paraparesis: involves weakness of both legs.

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12
Q

What type of lesions present as Brown-sequard syndrome

A

Hemicord lesion

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13
Q

How do hemicord lesions presents?

A

As Brown-sequard syndrome
Pain & temperature: loss in contralateral side to lesion, sensation still in ipsilateral side
Joint, position, vibration & sensation: Loss in ipsilateral side, sensation still in contralateral side to lesion.
UMN weakness in the ipsilateral side to lesion.

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14
Q

What is a syrinx

A

A fluid filled cavity within the spinal cord, tends to affect grey matter very close to the midline

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15
Q

What loss will a syrinx cause?

A

Usually pain and temperature, on the same side as the syrinx
sometimes some motor signs as it expands and involves anterior horn cells

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16
Q

what is the condition called when syrinx form

A

Syringomyelia

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17
Q

What can cause loss of pain and temperature sensation

A

Anterior spinal artery stroke
Syringomeglia

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18
Q

What is caused by anterior spinal stroke

A

Loss of pain and temperature sensation bilaterally below stroke
Still has JPS, vibration sense
Will have UMN weakness as anterior horn cells will be affected by the stroke.

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19
Q

Surgical Causes of myelopathy

A

Tumour
Vascular abnormalities
Degenerative (spine)
Trauma

20
Q

Medical causes of myelopathy

A

Congenital/genetic

Inflammation
Vascular: ischaemic/haemorrhage
infective
Metabolic: B12 DEFICIENCY
malignant: infiltrative/paraneoplastic
Idiopathic

21
Q

Examples of Congenital/genetic myelopathy

A

Hereditary paraperisis, spinocerebellar ataxias

22
Q

Examples of Inflammatory Myelopathy

A

Demyelination (MS)
autoimmune (systemic lupus)
sarcoid

23
Q

Examples of Infective myelopathy

A

Viral: Herpes simplex/zoster, EBV, CMV (cytomegalovirus), measles, HIV
Bacterial: TB, Lyme, syphilis, brucella
Other: schistosomiasis

24
Q

What are the main investigations for myelopathy

A

Imaging: MRI
investigating cause: Bloods (B12), CSF (inflammation)

25
Q

Where does the anterior spinal artery originate from, and what does it supplie?

A

It is a branch of the vertebral artery (upper half), and branch from a lumbar artery (lower half)
The anterior half of the spinal cord, which is supplied by sulcal arteries from the anterior spinal artery

26
Q

Where does the posterior originate from

A

The vertebral arteries as well.
the anterior artery branches off before the posterior arteries.

27
Q

Where are anterior spinal artery strokes most common?

A

where the upper and lower half of the anterior spinal artery meet as there is a watershed area at this point

28
Q

What is the clinical presentation of Spinal cord stroke

A

may have vascular risk factors
Sudden onset/ few hours
Pain: Back pain/radicular(radiates to anterior abdomen)
Weakness (paraparesis: rather than quadraparesis)
Numbness and paraesthesia
Urinary symptoms (retention followed by bladder and bowel incontinence as spinal shock settles)

29
Q

Why do spinal stroke patients tend to present with paraparesis, rather than quadraparesis

A

The thoracic blood flow is very vunerable, therefore ischaemia in this region will only affect the lower limbs

30
Q

what are the signs of spinal cord stroke

A

Present as Brown-sequard syndrome
(usually anterior, dorsal columns spared)
Mid thoracic
may be spinal shock

31
Q

what is spinal shock

A

Rapid shut down of spinal cord
No UMN signs (take time to develop)
Intermediate phase: absent reflex, low tone
No extensor plantar

32
Q

What indications can show UMN damage during spinal shock

A

Sensory changes, sudden onset and weakness.

33
Q

How would you treat spinal cord stroke

A

Reduce risk of recurrence
OT and physiotherapy
Manage vascular risk factors

Wouldnt thrombolyse spinal cord stroke.

34
Q

How would you reduce recurrence of spinal cord strokes

A

Maintain adequate BP
Reverse Hypovolaemia/arrhythmia
Antiplatelet therapy (aspirin, clopidogrel

35
Q

what is the Spinal cord stroke prognosis

A

Unless significant motor recovery in first 24 hours chance of major recovery is low
Pain may be persistent –> significant contributor to disability

20% mortality
35-40% have more than minimal recovery
60% left with significant disbility.

36
Q

What can cause B12 deficiency

A

Diet (vegans)
Pernicious anaemia: autoimmune condition in which antibodies to IF prevent B12 absorption
Total gastrectomy, Chron’s, tape worms.

37
Q

what is required for B12 absorption

A

Intrinsic Factor: secreted from stomach, and B12+IF reabsorped in ileum.

38
Q

what aspects of the nervous system will B12 deficiency affect

A

Myelopathy
Peripheral Neuropathy
Most common 2 to be affected in early stages

Will be affected if left low enough for long enough
Brain
Eye/optic nerves
Brainstem
Cerebellum

39
Q

What is paraesthesia

A

numbess or tingling senstation of hands/feet

40
Q

What are the signs and symptoms of B12 deficiency

A

Paraesthia hands and feet, areflexia.
First UMN sign: extensor plantar
Painless rentetion of urine
Loss of JPS and vibration sense, relative sparing of pinprick

41
Q

What is Degraded in the spinal cord in B12 deficiency

A

Corticospinal tracts–> paraplegia
Dorsal columns: sensory ataxia

42
Q

what are the investigations for B12 deficiency

A

FBC/ Blood Film (look for raised MCV, megaloblastic aneamia)
B12
B12 metabolites
Can have normal FBC and Blood film but low B12

43
Q

What is the treatment for B12 deficient myelopathy

A

Intramuscular B12 (quicker the better)

44
Q

What half of the spinal cord is usually affected by B12 deficency

A

The dorsal half

45
Q

B12 deficiency vs Spinal cord stroke

A

Stroke: usually affects the anterior half
B12: usually affects the posterior half

Year 2 Neuro (14 decks)

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